title: The value of the 2005 International Society of Urological Pathology (ISUP) modified Gleason grading system as a predictor of biochemical recurrence after radical prostatectomy.
abstract: OBJECTIVE
  To compare time and risk to biochemical recurrence (BR) after radical prostatectomy of two chronologically different groups of patients using the standard and the modified Gleason system (MGS).
  
  
  METHODS
  Cohort 1 comprised biopsies of 197 patients graded according to the standard Gleason system (SGS) in the period 1997/2004, and cohort 2, 176 biopsies graded according to the modified system in the period 2005/2011. Time to BR was analyzed with the Kaplan-Meier product-limit analysis and prediction of shorter time to recurrence using univariate and multivariate Cox proportional hazards model.
  
  
  RESULTS
  Patients in cohort 2 reflected time-related changes: striking increase in clinical stage T1c, systematic use of extended biopsies, and lower percentage of total length of cancer in millimeter in all cores. The MGS used in cohort 2 showed fewer biopsies with Gleason score ≤ 6 and more biopsies of the intermediate Gleason score 7. Time to BR using the Kaplan-Meier curves showed statistical significance using the MGS in cohort 2, but not the SGS in cohort 1. Only the MGS predicted shorter time to BR on univariate analysis and on multivariate analysis was an independent predictor.
  
  
  CONCLUSIONS
  The results favor that the 2005 International Society of Urological Pathology modified system is a refinement of the Gleason grading and valuable for contemporary clinical practice.
authors.affiliation: School of Medicine, State University of Campinas (Unicamp), Campinas, SP, Brazil, athanase@fcm.unicamp.br.
authors.forename: Athanase
authors.initials: A
authors.lastname: Billis
authors.forename: Maisa M Q
authors.initials: MM
authors.lastname: Quintal
authors.forename: Luciana
authors.initials: L
authors.lastname: Meirelles
authors.forename: Leandro L L
authors.initials: LL
authors.lastname: Freitas
authors.forename: Larissa B E
authors.initials: LB
authors.lastname: Costa
authors.forename: João F L
authors.initials: JF
authors.lastname: Bonfitto
authors.forename: Betina L
authors.initials: BL
authors.lastname: Diniz
authors.forename: Paola H
authors.initials: PH
authors.lastname: Poletto
authors.forename: Luís A
authors.initials: LA
authors.lastname: Magna
authors.forename: Ubirajara
authors.initials: U
authors.lastname: Ferreira
mesh_terms: D001707:Biopsy, Needle; D002277:Carcinoma / Q000097:blood / Q000473:pathology* / Q000601:surgery; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local / Q000097:blood / Q000473:pathology*; D017410:Practice Guidelines as Topic; D016016:Proportional Hazards Models; D011467:Prostate / Q000473:pathology*; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000097:blood / Q000473:pathology* / Q000601:surgery; D012189:Retrospective Studies; D018570:Risk Assessment; D013997:Time Factors
chemical_list: D017430:Prostate-Specific Antigen